At the start of a new year, it often seems that everywhere you look, someone is trying a new diet. But whether we resolve to change our eating in order to lose weight, improve our overall health, or just “get back on the wagon” after holiday indulgences, strict dieting might not be the healthiest habit to form as 2020 starts. In fact, most crash diets can have the opposite outcome to the one we hope for—weight gain. As we ring in the new decade, let’s look at what it would be like to adopt a non-diet approach to health, instead striving for a weight-neutral, evidence-based healthcare model for individuals with a concern about their weight. This approach is often used in conjunction with the Health at Every Size® paradigm, as well as models like intuitive eating and mindfulness. The main emphasis of these non-diet approaches is to shift the focus from weight loss to overall well-being.

Back up—what is Health at Every Size®?

Health at Every Size® (HAES®) is a trademarked paradigm that rejects the use of weight and body size as a proxy for overall health. Rather, HAES addresses health from a social-ecological perspective, emphasizing that health is affected by our genetics, personal behaviors, family and social circles, physical environments and public policy. While weight may be impacted by these different factors, it is not the exclusive determinant of someone’s health. Often, chronic disease and health status are not things we can see at first glance; consequently, a person’s appearance doesn’t tell the whole story of their health. Thus, HAES directly addresses the negative impact of weight stigma and takes the focus of our overall healthcare away from weight. The five principles of HAES are weight inclusivity, health enhancement, respectful care, eating for well-being and life-enhancing movement.

What else does the non-diet approach entail?

Adopting a non-diet approach to health encourages us to look beyond physical characteristics to determine the overall picture of one’s health, advocating for body acceptance, self-compassion and body attunement. Furthermore, the non-diet approach encompasses a framework known as intuitive eating, which has ten principles. These principles encourage us to get in tune with our body’s hunger cues, honor our feelings without using food, find exercise we enjoy, and find satisfaction in food, among other tenets. Lastly, the non-diet approach also incorporates mindfulness techniques, which may help reduce judgement and increase self-awareness and self-compassion.

Does the non-diet approach contradict what we know about weight?

The doctrine behind the non-diet approach may be hard to swallow because there is a large body of research linking high body mass to chronic diseases like cardiovascular disease, Type 2 diabetes and cancer. However, contrasting evidence suggests that a higher body mass index (BMI) does not increase disease or death risk, except in the most extreme cases. The same is true for extremely low BMI values. In light of this scientific evidence, proponents of the non-diet approach argue that a simple number such as body weight cannot be the single determinant of one’s disease risk. Recent research has assessed the role of “fitness versus fatness,” showing that “unfit” individuals are at greater risk for chronic disease and early death, regardless of their BMI. These findings argue that a person’s habits and lifestyle are more important determinants of health than that person’s weight.

Another contradiction to the predominant thinking on weight loss is set-point theory. This is the idea that our individual bodies are genetically programmed to function optimally at a certain “set-point” weight, which may range across ten or twenty pounds. For one person, that genetic set point might be smack-dab in the middle of the defined “normal” BMI range; but for another, it may be in the “overweight” or “obese” category. According to set-point theory, individual bodies are genetically programmed to function best within their set-point weight range—regardless of how those ranges compare with the bodies of others or with the BMI chart ranges.

Weight stigma affects overall health.

When our society says that one weight is OK and another is not, that messaging, also known as weight stigma, can have an adverse impact on a person’s physical and mental health. Weight stigma can show up anywhere, and while it is not often assessed as a confounding data variable (a variable that could cause a potentially false association) in research studies, it has been independently linked with an increased risk for chronic diseases and overall mortality. In fact, people with larger bodies are less likely to trust healthcare providers and may even avoid healthcare altogether for fear of discrimination. Weight stigma also disproportionately affects marginalized groups, and factors like stress, income and/or access to healthcare further impact one’s risk for chronic disease. Applying health principles espoused by the non-diet approach may help eliminate weight stigma and improve our overall physical and mental health.

Could a non-diet approach work for you?

While crash diets and exercise programs are very appealing at the start of a new year, philosophies like the non-diet approach offer a gentler approach to healthy living and an antidote to the harmful effects of weight stigma. Considering our food and diet through this lens opens the door for intuitive eating and mindfulness, which take the focus off weight loss and move it toward the development of long-term habits.

This blog post includes contributions by Courtney Schupp, MPH, RD, our 2019 Sylvia Rowe Fellow and Alyssa Pike, RD.